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tv   Senate Health Hearing on Pain Management and New Treatments  CSPAN  February 13, 2019 7:08am-9:14am EST

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marijuana. captioning performed by vitac
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captioning performed by vitac >> -- what can we do -- is there anything other than that that we can do to open up the ability to research the pros and the cons of medical use of cannabis? or is that -- is that the impediment that we've got to try to figure out how to deal with? dr. coop? >> i was going to punt this. i would say that this is a decision that the national institute on drug abuse, with the experts that could know all the confounding factors, it
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would be something that i think we should charge those guys with coming up with what is the best way forward. >> okay. well, thank you all for your answers and thanks for being here. thank you, mr. chairman. >> thank you, senator jones. senator murray, do you have additional comments? >> i just would like to thank all of our panelists for being here today. this has been i think really an interesting and eye opening and important hearing and i want to thank all of you for your help today. >> well, i agree with senator murray's sentiments. i only have one question. several of you have mentioned in response to questions from senators that what we could do about this is public education. well, that's what we are attempting to do today. i mean, the united states senate is a forum that help lead the way to recognize opioid abuse and try to deal with it and we should at the same time try to lead the way to determine whether there is some unintended consequences and whether the millions of americans who live with pain are not able to deal
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with pain as a result of the reaction to the effort to stem opioid abuse. we've heard today that reimbursement policies are important, that primary care doctors and their education is important, we've talked about the most promising non-addictive pain medicine that's been a -- that's been a priority of senator murray in her role as senior democrat on the appropriations committee that deals with health and this committee where we've attempted to push more funds into the national institutes of health toward nonaddictive treatments and medicines, and dr. collins has been here to testify on that and is working in a variety of ways to accelerate that. we've talked today about pharmacists and what their role might be as we go along, but i wanted to ask one last question
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about the cdc, the center for disease control, recommendations. they're not law, they're not rules that anyone has to follow, but the cdc is enormously respected in states and in the medical profession and in this environment. sounds to me like ms. steinberg, that your experience of using a low dose of hydrocodone and one other over the counter medicine for ten years to relieve pain wouldn't hit with the cdc guidelines for your doctors. so what recommendations -- my final question would be, and you can elaborate if you'd like to after you leave and you can submit it in writing, but each of you, what would be your recommendations about the existing guidelines of the center for disease control guidelines for opioid abuse and how we can make sure that while we're dealing with the opioid
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epidemic that we don't make it difficult or impossible for people who need opioids to relieve their pain to get them? let's start with you, ms. steinberg. >> yes, i think the best thing you can do is have the cdc guidelines revised. they really have been taken as law. as the vds behind them, people think that those are based on strong science and they're not. so the pain management task force that congress did wisely create of pain management experts is producing a report now and the report specifically reviews the cdc guidelines and makes excellent recommendations on how to revise them. i really think that congress should ask cdc to revise those guidelines based on the task force report. dr. gazelka and i both serve on that task force and they really need to be revised. cdc are not pain experts and they did not use pain experts to create those guidelines, sadly. >> well, the cdc deals with
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epidemics and obviously we had an epidemic. i hear your suggestion and maybe that's the subject for another hearing. >> nih is the best place to put pain. nih has an office of pain policy. cdc has no pain section. i've done tons of research on cdc to understand why their attitude towards pain is the way it is. this he don't have pain experts. nih is the place really that should decide those things. they have the office of pain policy, they know about pain research and i think they are the best people to make a decision like that and to pull the experts together. they have done the best job with the national pain strategy and with everything else. i really don't think it belongs to the cdc. >> thank you, missteinberg and thank you, again, for making the effort to come today. dr. gazelka. >> i think the best thing that could happen with the cdc guidelines that people understand what they were intended for. they were intended to advise primary care providers. they were not intended to -- to provide hard and fast rules.
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i actually like the cdc guidelines, at the risk of having tomatoes thrown at me, we use those guidelines to form our chronic pain management guidelines at the mayo clinic. i think they have a lot of good advice on how you monitor a patient appropriately when you place them on opioids. the doses that are mentioned probably are not scientifically based as we would prefer that they would be, but they do not say don't use chronic opioids, they suggest doses where you might kind of yellow light, red light become concerned with the use. so those numbers are concerning somewhat, but i think that the basis of the guidelines was sound as far as the intention of them. where the numbers came from is probably more questionable. >> do you see those guidelines as inconsistent with, say, a decision by a mayo team that for a knee surgery 16 days of opioids would be appropriate? >> yeah, i think that there's very little mention, as i said,
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of acute pain management. they were not really intended to address acute pain management as much as chronic pain management. they do suggest that you limit to three days or seven days unless there is a compelling reason to do otherwise and i think that leaves some room for physician -- i think that leaves some room for, you know, for physician -- >> but that's per prescription, right? >> that's correct. >> it's not for ever. >> for acute prescribing, that's right. for a one-time incident or surgery, yeah. not for chronic pain. the guidelines within are different. >> and just for the layperson which most of us are, what's a short description of a difference between chronic and acute pain? >> yeah, so we have considered in the medical literature typically three months has been used to describe the transition to chronic pain. we've used 45 days at mayo just to allow our surgeons a shorper ti shorter time that they would be prescribing, but i think between 45 days and three months,
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anything over that time period is typically considered chronic. >> dr. coop? >> there's not much that i can add that hasn't already been added by my learned colleagues whept it's the law of unintended consequences and people take these guidelines as law. we need to reassess them and we need to remind everyone that they are, indeed, education and a place to start. that's what we need to do. >> thank you. dr. rao-patel? >> yes, so i will just add this comment and say i agree with everything my colleagues have said here, but what i will say is that the reason that the cdc made these guidelines is part of the reason that we have an opioid epidemic now, is because there was a lack of education and knowledge on how to prescribe these medications. so i won't pick on any other specialty but my own, i know they're geared towards primary care physicians but they can be used for any specialty. as a physiatrist i will say that physiatrists used to write a lot of opioids, with he write a lot of opioids, a lot of us are
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interventional pain management doctors, a lot do pain management which is what i did. the goal of the cdc is correct, there were not a lot of guidelines on how to prescribe these medicines so people would go into their physicians on monday morning after having a flare up of their back because they painted their home and would come home with a 30-day prescription of opioids which is not necessary. i think the intentions were correct. i think like any other guidelines, they're guidelines, there are going to be people who fall outside of those guidelines and it's entirely appropriate to prescribe outside of them. i think that's where the universal precautions comes in in managing chronic pain and making sure you are assessing a patient's function, a patient's -- how they're responding to the pain or are there any other risk/benefit ratio, do they have informed consent, et cetera. i think like any guidelines they are open for revision, just because something was written one month ago, three months ago, six months ago doesn't mean that six months from now the guidelines have not changed. so what i would say is that they are a revolving door of
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guidelines, i think there's certainly room to improve them, to change them, but i do understand the reason that they were written and a lot of that is the reason that we are here today. >> thank you very much. this has been a follow-up to what was -- the president described as the most important federal law to try to fight a public health epidemic, that was the opioids epidemic, but as i mentioned earlier, this committee, which as you can see from the personalities on the committee has broadly divergent views, generally left to states, physicians and agency hoe write guidelines, these decisions about limits on prescriptions rather than try to write an inflexible federal law that applied everywhere. so there's plenty of room for discussion and adjustment if adjustments need to be made. we welcome any follow-up comments you would like to make.
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you can tell by the interest from the senators today that we're very interested in the topic. the hearing record will remain open for ten days. members may submit additional information during that time if they would like. thank you for being here. the committee will stand adjourned. there are nearly 100 new members of the house of representatives this year. ohio, west virginia, maryland,
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mississippi and washington are five of the states that added one new member. representative anthony gonzalez was a football star at ohio state before the indianapolis colts drafted him in 2007. after injuries cut short his professional football career, representative gonzalez earned his mba at stanford business school. he is the first latino elected to ohio's congressional dell dpags. representative carol miller served over a decade in the state house before voters in west virginia's third district elected her to congress. politics runs in her family. she's the daughter of former congressman samuel divine whose seat would later be filled by future ohio governor and 2016 presidential candidate john kasich. congressman michael guest was a local pros turt in am st for 25 years, district attorney before his election to the house. he is also a sunday schoolteacher at his local baptist church.
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representative david trone and his brother opened a small liquor store in delaware in the early 1990s. the company eventually moved its headquarters to maryland and has extended to become the largest independent fine wine retailer in the country. washington's eighth district elected representative kim schrier a pediatrician and the only female doctor in doings. new congress, new leaders. watch it all on c-span. here is a look at our live coverage wednesday on c-span the house is back for legislative business at noon to consider a war powers resolution that boo end u.s. military assistance to saudi-lead forces in yemen's civil war. on c-span 2 the senate returns at 10:00 a.m. eastern to continue debate on the nomination of william bar to be u.s. attorney general. and on c-span 3 representatives from t-mobile and sprint testify at a joint house subcommittee hearing about the proposed merger between the two companies. later there is another hearing
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on efforts to combat sexual assaults at military service academies. our live coverage of the funeral for michigan congressman john dingell continues thursday morning at 10:30 eastern. a funeral mass will be held at holy trinity catholic church in washington, d.c. speakers include bill clinton, house majority leader ten gee hoyer and john boehner. watch the funeral services live on c-span and c-span.coring or listen with the free c-span radio app. next montana governor steve bullock delivers his fourth and final state of the state address. the governor spoke before a joint session of the montana legislature in helena, he outlined his legislative priorities which include economic development, education,

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